Hammer Toe: causes, symptoms and treatments

Updated 6/30/2022
In this video, we talk about the causes of hammertoe and how to correct them.

What's a Hammer Toe?


A hammertoe is a fairly common foot problem that occurs when the middle joint of the toe develops an abnormal bend and becomes flexed or bent downward. This is due to a muscle imbalance around the toe joints. 


This imbalance is what causes the toe to bend at one or more joints, eventually pushing the middle of the toe upward in a claw-like position.


Unfortunately, a hammertoe (also called claw toes, mallet toes, or retracted toes) causes pain and never gets better without intervention. The sooner it is treated, the better the outcome and the shorter the recovery.

What Causes a Hammer Toe?

Though hammer toes are principally hereditary, they can develop over time as the toe’s tendon is abnormally stretched and pulled. This foot health issue can happen due to a few different risk factors, including:


  • Trauma or injury to the foot or toe
  • Abnormally high arches
  • Flat feet
  • A weak calf muscle, or leg muscles
  • Wearing shoes that are too tight, too pointy, or lack arch support as well as children wearing shoes they have outgrown.
  • Strain caused by a bunion: the second toe elevating and becoming hammered to make room for the big toe that is moving toward it.
  • Diseases that affect the bones, muscles, tendons, and ligaments. Arthritis, diabetes, neuromuscular disorders, and stroke can all increase the likelihood of hammertoe.




Hammer Toe Symptoms

The symptoms of hammertoe can cause problems with walking and lead to other foot problems, such as blisters, calluses, and sores. Pain is caused by constant friction over the top of the toe’s main joint.


It may be difficult to fit into some shoe gear due to the extra space required for the deformed toe. In many cases, there will be pain on the ball of the foot over the metatarsals along with callus formation. This is due to the toes not functioning properly, failing to properly touch the ground during the gait cycle. The ball of the foot then takes the brunt of the ground forces, which causes chronic pain.


How is a Hammer Toe Diagnosed?

Clinical observation of the toe is made to assess what part of the toe is involved in the deformity. We will also determine if the hammer toe is flexible (able to be reduced) or rigid. Plain x-rays also determine the extent of the contracture. An examination of the entire foot identifies the root cause of the deformity.


Non-invasive Hammer Toe Treatment Options

Conservative treatment is limited to accommodation, not correction, of the deformity, though some patients find the relief they can get from these options to be more than enough to put off or even avoid surgery. These include:


Better Footwear

Choose comfortable proper fitting shoes with a wider toe box and arch support. Shoes made with Lycra are often a good choice, because the material stretches generously around the irregular toe structure. Avoid pointy or narrow shoes, which can aggravate the deformity and cause painful corns. If you wear high heels, keep the heels at 2 inches or lower. Your doctor can help you choose shoes that fit your needs.


Toe Braces and Strapping

Some toe braces and strapping techniques take some pressure off the toes during gait.


Padding your Corns and Calluses

Your foot and ankle surgeon can either provide you with or prescribe these that can help protect your corns from getting more irritated. There are also over-the-counter pads you can try. But do not use any that are "medicated" as they can contain various amounts of acid which are not helpful and can be harmful.


Custom Orthotics

Custom molded orthotics can redistribute the forces through the tendons that control the toe, lessening the pain and extent of the deformity.


Callus Control

The calluses on the toe and the ball of the foot can be shaved occasionally to reduce some pain and pressure, although they will return due to the constant deformity.


Use Foot Rollers

Your doctor can provide you with a therapeutic foot roller that you can use at home to stretch and massage the tendons causing your deformity. Many of these products can also be frozen before use, which can reduce inflammation and pain.


Surgical Treatment Options for a Hammer Toe

Hammertoe Representation

Surgical correction is needed to bring the toe into a corrected position and increase its function. Correction of the hammer toes is a simple outpatient surgery, with limited downtime.


Fusing the Toe: PEEK Implant System

The best option is to fuse the deformed and contracted toe. This limits the need for future surgery and the deformity to return.


The PEEK hammertoe implant system is a next-generation implant that was designed with the help of our physicians. The implant is made of a material that is similar to bone, and not visible on an x-ray. This allows the surgeon to visualize the fusion site on an x-ray, without the shadows of titanium that is used in traditional implants.


What further differentiates the Peek implant from other products is that it can easily be removed and has great fixation strength. It also allows for the toe to be aligned in a straight position or at a 10-degree angle for a more natural look.


OSSIOfiber® All-natural Implant

We are proud to offer a revolutionary non-metal fixation option for hammertoe surgery called OSSIOfiber®. OSSIOfiber® is a bio-degradable polymer mixed with a mineral fiber that slowly grows into the human bone, reinforcing the bone healing site. It is eventually eliminated completely and replaced by the body’s own bone through natural cellular turnover. So, the material not only integrates but actually adds strength to the surgical site.


Removing the Hammer Toe deformity

In certain cases, the removal of a small area of bone in the deformity area will decrease pain and limit the need for a surgical waiting period that is found with fusions. Although the toe is not as stable as with a fusion, in certain cases, an arthroplasty is the best option.


See our patient's before and after picture gallery of hammertoes surgeries here.

Benefits of Hammertoe Surgery

After surgery, patients will be able to look forward to getting back to the activities they love. Pain and discomfort are corrected and there will no longer be any pain when walking or hiking because the toe joints will no longer feel pressure or rub against the inside of shoes. This leads to improvement in health which, in turn, allows the patient to lead an active lifestyle. They will no longer feel self-conscious about taking their shoes off at the beach and feel comfortable walking barefoot.


Hammer Toe Surgery Recovery

The procedure to correct a hammer toe lasts approximately one hour. Following the surgery, patients are in a walking boot for 6 weeks and then about two more weeks of swelling decline in a shoe. 


Why Choose University Foot and Ankle Institute for Hammer Toe Treatment?

We've revolutionized hammer toe correction over the last two decades. We pride ourselves on offering the most advanced diagnostic technology and treatment options available.

UFAI surgeons offer their revolutionary approach to the surgical treatment for hammertoes and related foot deformities. We use a screw or absorbable pin for rapid healing and early weight-bearing. There is often no need for a pin to stick out of the toe post-surgery, which may be a source for infection and rigid fixation. Our goal is to get you back on your feet in the least invasive, quickest way possible.



Hammer Toe and Hammer Toe Surgery FAQs


Q: What is a hammertoe?

A: A hammertoe is a deformity of the toes where there is a downward contracture at the middle joint of the toe as well as an upward contracture of the joint closest to your toenail. The disfiguration results from an imbalance of the tendons, ligaments, or muscles that hold your toe in place. Hammertoes can affect any toe, but most commonly affects the second toe. Hammertoes can be very uncomfortable and even painful for patients, especially when wearing shoes that are snug around the toes.


Q: What are mallet toe and claw toe?

A: Similar to hammertoe, mallet and claw toe are deformities that cause the toe to bend downward. Instead of the middle toe joint, mallet toe affects the joint closest to your toenail, and claw toe affects the joint nearest to the ball of your foot. Mallet toe and claw toe have many of the same causes, symptoms, and methods of treatment as hammertoe.


Q: Are hammertoes the same as corns?

A: No, but corns often form alongside hammertoe. Corns look like tough bumps of skin that form over a foot or toe joint. Corns are essentially layers of skin that have grown in response to the joint rubbing on the inside of your shoe. A corn often develops on a joint affected by hammertoe because the deformity prevents your shoes from fitting properly, causing irritation to the skin. Blisters and calluses may form near hammertoes for the same reason.


Q: How is hammertoe treated?

A: Mild and moderate cases of hammertoe are usually treated conservatively with orthotic inserts and well-fitting footwear that allow for comfortable movement and promote healing.


Q. How does hammertoe surgery affect performance in sports, especially football and running?

A. Hammertoe correction surgery actually helps performance in sports, especially with grip and foot strength.


Q: Can hammertoe be treated with surgery?

A: Severe hammertoes may be treated with surgery. Surgery can reduce pain and improve the appearance and functionality of the toes. Hammertoe correction surgery is an outpatient procedure with very little downtime.


Q: What can I expect during hammertoe surgery?

A: Hammertoe surgery is an outpatient procedure performed under sedation or general anesthesia, so you will not be awake during the procedure. Hammertoe surgery falls into two main categories:


  1. Joint resection – a procedure to remove the crooked portion of the joint and repositioning the toe bones so that they point straight out again. This is also known as arthroplasty.
  2. Bone-mending – a procedure in which entire joint is removed and repositioned in such a way that the bones fuse together. Surgical hardware is often used to fix the bones into place. The joint will no longer be able to bend after recovery. Fusing the toe is the best option and limits the need for future surgery and the deformity to return.


Q: How long does it take before you can walk after hammertoe surgery?

A: At UFAI, our patients are weight-bearing in a boot right away. Patients are normally in a boot for 4 - 6 weeks and after that can then wear regular shoes.


Q: What can I expect during my recovery from hammertoe surgery?

A: Most patients are able to walk with the help of crutches and a special boot provided by their doctor. Pain and swelling are normal for about a week following surgery. Your doctor can prescribe you medication to manage the pain. Get plenty of rest and keep the foot elevated while sitting or lying down.

After hammer toe surgery:

  • 2-3 weeks: Stitches may be removed.
  • 4-6 weeks: Any surgical pins that were used may be removed.
  • 6 weeks: Average recovery time. Some people may return to their normal routine as soon as 2 weeks, while others may take up to 3 months. Generally, the pinky toe is the quickest to recover, while the second toe takes the longest.


Q: Can a hammertoe come back after surgery?

A: Some cases of hammertoe do relapse following surgical correction. Depending on the type of surgery and your aftercare routine, the deformity may return. If your toe begins curling again and you are experiencing discomfort, visit your foot and ankle specialist.

 Have any Hammer Toe questions we should add to our FAQ's? Please let us know by clicking here.




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